Therapeutic competition among diseases in elders: Frequency and outcomes

描述（由申请人提供）：在这项试点研究中，我们开始研究存在潜在治疗竞争（即一种疾病的治疗恶化了另一种疾病或干扰治疗反应）的并发慢性疾病的患病率和健康影响。我们专注于治疗竞争，这是多发病引起的几个临床困境之一，因为其固有的潜在伤害。主要目的是确定：1)在老年人中，存在潜在治疗竞争的选定慢性疾病同时发生的患病率；2)老年人在接受和坚持治疗方面是否存在差异，是否有选择的共同发生的条件，存在潜在的治疗竞争。探索性目的是根据对可能存在治疗竞争的并发疾病所接受的治疗，确定患有选定疾病的老年人的健康和疾病特异性结局是否存在差异。我们将评估与潜在治疗竞争共发生疾病的频率和后果的选定疾病包括糖尿病、心力衰竭、慢性阻塞性肺病和骨质疏松症。在这项初步研究中，我们将重点放在作为治疗竞争来源的药物上。选择与所选疾病有潜在治疗竞争的共患疾病是基于：1)证据；2)疾病生物学及治疗；3)疾病专科指南。参与者是两个具有全国代表性的老年人纵向队列的成员，均来自美国各地。医疗支出小组研究（MEPS）有超过11,000名参与者，医疗保险现行受益人研究（MCBS）有超过18,000名65岁以上的参与者。MEPS和MCBS都包含大量关于慢性病、疾病治疗（包括药物治疗）、健康结果和选定疾病的疾病特异性结果的纵向数据。这项初步研究的结果将提高人们对这一重要但研究不足的领域的认识和理解，并为今后的研究奠定方法学基础。由于越来越多的老年人患有多种疾病而引起的临床困境要求仔细审查，以确保我们的诊断、预防和治疗手段得到尽可能安全和有效的部署。

DESCRIPTION (provided by applicant): In this pilot study, we begin to examine the prevalence and health effects of co-occurring chronic diseases for which there is potential therapeutic competition (i.e. the treatment of one disease worsens another disease or interferes with treatment response). We focus on therapeutic competition, one of several clinical dilemmas arising from multi-morbidity, because of the inherent potential to inflict harm. The Primary Aims are to determine: 1) the prevalence among older adults of the co- occurrence of selected chronic diseases for which there is potential therapeutic competition; and 2) whether there are differences in treatments received, and adhered to, by older adults with, vs. without, selected co-occurring conditions for which there is potential therapeutic competition. The exploratory aim is to determine whether health and disease-specific outcomes differ among older adults with a selected disease according to the treatment received for co-occurring diseases with potential therapeutic competition. The selected diseases for which we will evaluate the frequency and consequences of co-occurring diseases with potential therapeutic competition include diabetes, heart failure, COPD, and osteoporosis. For this pilot study, we focus on medications as the source of therapeutic competition. The co-occurring diseases with potential therapeutic competition with the selected diseases are chosen based on: 1) evidence; 2) biology of the diseases and treatments; and 3) disease specialty guidelines. Participants are members of 2 nationally representative longitudinal cohorts of older adults, both sampled from throughout the U.S. The Medical Expenditure Panel Study (MEPS) has over 11,000 and the Medicare Current Beneficiary Study (MCBS) over 18,000 participants age 65+ years. Both MEPS and MCBS include a wealth of longitudinal data on chronic diseases, disease treatments including medications, health outcomes, and disease-specific outcomes for the selected diseases. Results of this pilot study will heighten awareness and understanding of this important but understudied area and lay the methodological groundwork for future studies. The clinical dilemmas arising from the growing numbers of older adults with multi-morbidity mandate careful scrutiny to ensure that our diagnostic, preventive, and therapeutic armamentaria are deployed as safely and effectively as possible.